Adverse Childhood Experiences and Health Among a National Sample of Children

Background: Adverse Childhood Experiences (ACEs) negatively impact the health and well-being of children to adulthood.  ACES include family dysfunction and community-level stressors. Children exposed to ACES may experience developmental delays, poor emotional health, and adult health problems such as heart disease and depression as well as lower education and job skills compared to children who have not experienced ACES. However, little is known about how ACES may differ among ethnic groups or how ACES are related to access to health care. Poor access to care may exacerbate already poor health caused by ACES. The purpose of the current study is to identify risk profiles of ACES exposure among children and how ACES relate to ethnic group and health and health care access.

Methods:

Data and Sample: Extant data from the 2011-2012 National Survey of Children’s Health (NSCH) was used.   Responses from parents on behalf of children age 10 to 17 years was used. There were 44,763 children in this age group. The NSCH response rate is 55.3%. 

Measures: Six indicators of exposure to early childhood adversity including exposure to violence in the home and neighborhood.  ACES included yes or no responses to the following questions: (1) lived with a parent who died,  (2) lived with a parent who was incarcerated after their birth,  (3) witnessed parents being physically violent with one another (intimate partner violence),  (4) was a victim or witness of violence in their neighborhood,  (5) lived with anyone who was mentally ill, suicidal or severely depressed for more than a couple weeks, and  (6) lived with anyone who abused alcohol or drugs.

Outcome variable: Insurance status and self-reported health.

Demographic measures include: Age, gender, federal and poverty level.

Analytic Approach: Latent Class Analysis, a finite mixture model used to identify subpopulations from a larger sample. Subsequently, latent class regression was employed to examine explanatory variables in relation to latent class structure.

Results: Latent class analysis identified five classes: 1) 4% of children were in the  Multiple Risk class indicative of exposure to parental incarceration, family violence, mental illness, alcohol/drug abuse, and community violence; 2) 76% of children were in the Low-Risk indicative of low probability of exposure to any of the ACES; 3) 4% of children were in a class indicative of exposure to community violence; 4) 3% of children were in a class indicative of  exposure to parental incarceration and alcohol& drugs. 5) 13% of children were in class indicative of exposure to alcohol, drugs and mental health problems.

Latent class regression results showed that children who are black, Hispanic/Latino, uninsured, have poorer self-reported, or who are male have increased odds of being in the more severe ACES classes indicative of more family trauma compared to the low risk class.

Conclusion: Early identification and treatment of ACES in multiple care settings may serve in reducing health disparities. Integration of social work, public health and health care delivery systems will be necessary to address the effects of trauma on adolescent well-being across the life course and into adulthood.